FETAL DISTRESS DUE TO PLACENTAL INSUFFICIENCY AT 26-WEEKS THROUGH 31-WEEKS - A COMPARISON BETWEEN AN ACTIVE AND A MORE CONSERVATIVE MANAGEMENT

Objective: To compare perinatal mortality and short-term morbidity in extremely preterm infants with fetal distress due to placental insuffi ciency in two centers with different management attitude, Design: Retr ospective cohort study in two university hospitals of all infants with fetal growth retardation due to placental insufficiency resulting in signs of fetal distress at 26 through 31 weeks gestational age, during the years 1984 through 1989. Center A followed a conservative managem ent: in some cases the risk of major handicaps or mortality was estima ted so high, based on antenatally estimated fetal weight and gestation al age, that the decision was taken to abstain from treatment. In all other cases cesarean section took place, but only if fetal distress wa s obvious. Center B used a more active management: cesarean section wa s performed in all cases, sometimes with only minor changes in fetal h eart rate variability. Results: Overall survival differed significantl y: 55% (center A) versus 72% (center B), largely due to antenatal mort ality in center A. Discharge survival rate of liveborn infants was 81% in center A and 72% in center B. More than half of the postnatal mort ality was attributed to respiratory causes in both centres. An active management showed a tendency to a higher incidence of short-term morbi dity. Conclusion: Selection by antenatal prediction of postnatal morta lity using estimated fetal weight fails. Even in the group with the lo west birthweight postnatal mortality did not surpass 50%. Early interv ention may be associated with higher short-term morbidity. Long-term f ollow-up of these children is needed to discriminate between both poli cies with regard to further development of surviving infants.